femur and pelvis

• ap femur

  IR: 14x17 LW grid or bucky

  PT position: supine, proximal- medially rotate leg 15-20 degrees distal- medially rotate leg 5 degrees

  CR:perpendicular to the IR entering the femur

  SID: 40"

  Tech: kVp 73 mAs 16
• lat femur

  IR: 14x17 LW grid or bucky

  PT position: left or right lateral recumbent position with affected side down, flex knee 45 degrees, proximal- roll back 15 degrees distal- roll back 15 degrees or bring unaffected leg over

  CR: perpendicular to the IR entering the femur

  SID: 40"

  Tech: kVp 73 mAs 16
• ap pelvis

  IR: 14x17 CW grid or bucky

  PT position: supine, no rotation of pelvis, legs extended, separate heels and turn toes medially 15-20 degrees

  CR: Perpendicular to the IR entering MSp midway between the level of ASIS and the pubic symphysis

  SID: 40"

  Tech: kVp 77 mAs 20-25
• ap oblique modified cleaves pelvis

  IR: 14x17 CW grid or bucky

  PT position: supine, flex knees up as much as possible and drop them to the side

  CR: perpendicular to the IR entering MSP at a level 3" inferior to the ASIS

  SID: 40"

  Tech: kVp 77 mAs 20-25
• ap axial bridgman inlet pelvis

  IR: 10x12 CW grid or bucky

  PT position: supine

  CR: angled 40 degrees caudad entering MSP at the level of the ASIS

  SID: 40"

  Tech: kVp 77 mAs 32
• ap axial taylor outlet pelvis

  IR: 10x12 CW grid or bucky

  PT position: supine

  CR: angled 20-35 degrees for males or 30-45 degrees for females entering 2" distal to the superior border of the pubic symphysis

  SID: 40"

  Tech: kVp 77 mAs 32
• femur

  A) greater trochanter

  B) head

  C) neck

  D) lesser trochanter

  E) popliteal surface

  F) adductor tubercle

  G) medial epicondyle

  H) medial condyle

  I) lateral condyle

  J) lateral epicondyle

  K) intercondylar fossa (notch)

  
• femur

  A) hip joint

  B) body

  C) patella

  D) patellar surface

  
• proximal femur

  A) greater trochanter

  B) neck

  C) head

  D) fovea capitus

  E) greater trochanter

  F) intertrochanteric crest

  G) lesser trochanter

  H) body

  
• os coxae

  A) acetabelum

  B) anterior inferior iliac spine

  C) anterior superior iliac spine

  D) iliac crest

  E) ala

  F) body

  G) posterior superior iliac spine

  H) posterior inferior iliac spine

  
• os coxae

  A) upper body

  B) acetabelum

  C) ramus

  D) lower body

  E) ischial tuberosity

  F) lesser sciatic notch

  G) ischial spine

  H) greater sciatic notch

  
• pelvis

  A) pubic symphysis

  B) ischial spine

  C) obturator foramina

  D) inferior ramus

  E) superior ramus

  F) body

  G) obturator foramen

  
• pelvis

  A) greater or false pelvis

  B) lesser or true pelvis

  C) brim of pelvis

  
• pelvis

  A) inlet

  B) outlet

  C) plane of inlet

  D) cavity

  E) plane of outlet

  
• pelvis

  A) female pelvis

  
• pelvis

  A) male pelvis

  
• joints

  A) sacroiliac joint

  B) union of acetabelum

  C) hip joint

  D) symphysis pubis

  
• method 1 of finding the femoral head and neck


  draw a line from the ASIS to the pubic symphysis

  bisect that line

  femoral head in 1.5" distal

  femoral neck is 2.5" distal
• method 2 of finding the femoral head and neck


  find the ASIS

  go 1-2" medial

  go 3-4" distal
• patient prep

  pants off

  tie gowns
• radiation protection


  collimate to 10x12 LW and go in from there
• be vocal and ask questions

  communicate about what they can do

  ask if you can help

  dont force anything
• pediatric considerations

  bilateral for epiphyseal plates

  pelvis and bilateral hips

  parents can only do one thing

  kids are more flexible, toes may move without the knees moving
• geriatric considerations


  not as flexible

  get cold fast

  prop head up
• signs of a hip fracture


  shorter leg

  external rotation

  take an "as is" first

  OR hip
• indications


  pain

  trauma

  fracture

  dislocation

  osteoarthritis

  SCFE

  avascular necrosis

  DDH or CDH

  ankylosing spondylitis
• SCFE


  slipped capital femoral epiphysis

  most common in 10-16 year old boys
• avascular necrosis


  no blood to bone

  death
• DDH or CDH


  developmental dysplasia

  congenital dysplasia

  most common in first born girls and breech babies

  acetabulum is malformed
• ankylosing spondylitis


  chronic inflammatory disease

  can lead to fusion

  "bamboo spine"

  usually starts in sacrum